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Prognostic factors for acute myeloid leukemia patients with t(6;9)(p23;q34) who underwent an allogeneic hematopoietic stem cell transplant

Leukemia volume 26, pages 1416–1419 (2012)Cite this article

Allogeneic hematopoietic stem cell transplantation (allo-HSCT) is often selected as a curative treatment strategy for acute myeloid leukemia (AML). In particular, AML patients with poor cytogenetics at diagnosis are considered for allo-HSCT as the first-line therapy.1, 2, 3 Recently, we have reported that AML with the t(6;9)(p23;q34) abnormality, which predicts a very poor prognosis in patients treated with chemotherapy,4 is associated with an outcome in patients receiving allo-HSCT that is comparable to that in patients with a normal karyotype.5 However, 55% of the AML patients with t(6;9)(p23;q34) eventually had a negative outcome. We herein performed a further analysis for AML patients with t(6;9)(p23;q34) who received allo-HSCT to identify the prognostic factors affecting their overall survival (OS).

A total of 64 de novo AML patients with t(6;9)(p23;q34) detected in G-band staining at diagnosis, who received their first allo-HSCT between January 1996 and December 2007, were extracted from the databases of the Japan Society for Hematopoietic Cell Transplantation (JSHCT) and the Japan Cord Blood Bank Network. The cytogenetic data were analyzed according to the Southwestern Oncology Group criteria for each institution, instead of by central review.2 The clinical data were collected using a standardized report form, which was submitted at 100 days, 1 year and annually after HSCT. This study was approved by the Committee for Nationwide Survey Data Management of the JSHCT. Written informed consent was obtained in accordance with the Declaration of Helsinki. The OS was defined as the number of days from HSCT until death from any cause. Non-relapse mortality (NRM) was defined as death without relapse. Any patients who were alive at the last-follow-up date were censored. The analysis was performed using the R version 2.13.0 software program (R Foundation for Statistical Computing; www.r-project.org).6 The probability of OS was calculated using the Kaplan–Meier method and compared using the log-rank test. The probabilities of transplant related mortality and disease relapse were compared using the Grey test7 and were analyzed using the cumulative incidence analysis,6 while considering relapse and death without disease relapse as respective competing risks. The following variables related to the survival of the adult patients older than 15 years and their clinical data were compared in a univariate analysis: recipient characteristics (age; younger than 35 vs. older than 35 years, gender, performance status at diagnosis; 0 to 2 vs. 3 or 4, FAB classification; M2 or others, positivity for peroxidase in leukemic blasts at diagnosis; less than 50% vs. greater than 50%, cytogenetic abnormality), donor characteristics (age; younger than 35 vs. older than 35 years, gender, sex compatibility, compatibility of cytomegalovirus antibody serostatus, relationship; related vs. unrelated, and ABO compatibility), transplant characteristics (disease status at HSCT; complete remission (CR) vs. non-CR, use of total body irradiation as a preconditioning regimen, source of the graft; bone marrow, peripheral blood stem cell, cord blood (CB)), graft-versus-host disease prophylaxis; cyclosporine versus tacrolimus and the use of methotrexate. Multivariate Cox models were used to evaluate the hazard ratios associated with the prognosis. Covariates found to be significant in the univariate analyses (P⩽0.10) were included in the models. For both the univariate and the multivariate analyses, P-values were two sided, and outcomes were considered to be significant for P⩽0.05.

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Acknowledgements

We are indebted to all of the patients and the staff of the participating institutions of the Japan Society for Hematopoietic Cell Transplantation, the Japan Marrow Donor Program, The Japanese Cord Blood Bank Network and The Japanese Society of Pediatric Hematology. We also thank Ms Takako Sakai, data manager of the Japan Society for Hematopoietic Cell Transplantation Data Registry, for their excellent assistance.

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Author notes

  1. A Takami and Y Kanda: These authors contributed equally to this work.

Authors and Affiliations

  1. Department of Cellular Transplantation Biology, Kanazawa University Graduate School of Medical Sciences, Kanazawa, Ishikawa, Japan

    K Ishiyama, A Takami & S Nakao

  2. Department of Hematology, Tokyo Metropolitan Ohtsuka Hospital, Toshima, Tokyo, Japan

    K Ishiyama

  3. Division of Hematology, Saitama Medical Center, Jichi Medical University, Saitama, Saitama Prefecture, Japan

    Y Kanda

  4. Department of Hematology, National Hospital Organization Kumamoto Medical Center, Kumamoto, Kumamoto Prefecture, Japan

    M Hidaka

  5. Department of Hematology and Oncology, Osaka University Hospital, Suita, Osaka, Japan

    T Maeda

  6. Department of Hematology and Oncology, Nagoya University Graduate School of Medicine, Nagoya, Aichi, Japan

    T Naoe

  7. Department of Hematology, Toranomon Hospital, Minato, Tokyo, Japan

    S Taniguchi

  8. Department of Hematology/Oncology, Osaka Medical Center and Research Institute for Maternal and Child Health, Izumi, Osaka, Japan

    K Kawa

  9. Department of Cell Processing and Transfusion, Institute of Medical Science, University of Tokyo, Minato, Tokyo, Japan

    T Nagamura

  10. Department of Pediatrics, Hematology/Oncology, Kanagawa Children’s Medical Center, Yokohama, Kanagawa, Japan

    K Tabuchi

  11. Department of Hematopoietic Stem Cell Transplantation Data Management/Biostatistics, Nagoya University School of Medicine, Nagoya, Aichi, Japan

    Y Atsuta

  12. Department of Hematology, Tokyo Metropolitan Cancer and Infectious Diseases Center Komagome Hospital, Bunkyo, Tokyo, Japan

    H Sakamaki

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  1. K Ishiyama
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Correspondence to K Ishiyama.

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Ishiyama, K., Takami, A., Kanda, Y. et al. Prognostic factors for acute myeloid leukemia patients with t(6;9)(p23;q34) who underwent an allogeneic hematopoietic stem cell transplant. Leukemia 26, 1416–1419 (2012). https://doi.org/10.1038/leu.2011.350

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